Claims Customer Service Advocate II

Customer Service Advocate II is responsible for responding to customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates claims and/or non-medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures.

Schedule: Monday-Friday, 8:00 AM-5:00 PM during Training
Location: 8733 Highway 17 Bypass, Myrtle Beach 29575
Pay: Weekly Pay | $23.11 hourly

Work Environment: Office Setting

• Ensures effective customer relations by responding accurately, timely, and courteously to inquiries.
• Handles situations which may require adaptation of response or extensive research.
• Identifies incorrectly processed claims and processes adjustments and reprocessing actions.
• Examines and processes claims and/or non-medical appeals according to business/contract guidelines.
• Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes.
• Ensuring claims are processed according to established quality and production standards.
• Identifies complaints and inquiries of a complex level that cannot be resolved following desk procedures and guidelines referring to a lead or manager for resolution.
• Identifies and reports potential fraud and abuse situations.

Required Skills and Abilities: Good verbal and written communication skills. Strong customer service skills. Good spelling, punctuation and grammar skills. Basic business math proficiency. Ability to handle confidential or sensitive information with discretion.

Required Software and Other Tools: Microsoft Office.

Required Education: High School Diploma or equivalent

Required Work Experience: 2 years of customer service experience including 1-year claims or appeals processing OR Bachelor's Degree in lieu of work experience.